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HHS OIG Issues Fraud Oversight Strategic Plan for COVID-19 Response and Recovery

June 1, 2020

The United States Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) recently released its Strategic Plan for the oversight of COVID-19 response and recovery. In the plan, the OIG sets forth goals for its work around COVID-19 response and recovery. The four goals are to: (1) protect people; (2) protect funds; (3) protect infrastructure; and (4) promote the effectiveness of HHS programs.

The OIG’s objectives focus heavily on its routine work of preventing fraud, waste and abuse. Specifically, objectives include fighting fraud and scams that endanger HHS beneficiaries and the public; preventing, detecting and remedying waste or misspending of COVID-19 response and recovery funds; fighting fraud, waste and abuse diverting COVID-19 funding from intended purposes or exploiting emergency flexibilities granted to health and human services providers; protecting the security and integrity of IT systems and health technology; and supporting the effectiveness of federal, state and local COVID-19 response and recovery efforts. The OIG will use its risk assessment and data analytics tools, including artificial intelligence, to detect trends and patterns of suspicious activity.

Testifying before Congress last week, Principal Deputy Inspector General Christi Grimm told lawmakers, “We know from experience that fraud schemes proliferate during emergencies as greedy perpetrators exploit fear and confusion to steal." In the context of COVID-19 response and recovery, OIG promised to scrutinize the $175 billion spent through the Provider Relief Fund by auditing “fund recipients to assess whether they met use, reporting, and other requirements, and, where appropriate, recommend recovery of misspent funds.” Health care providers should also pay attention to the OIG’s actions to fight fraud and abuse that exploits emergency flexibilities granted to providers during the pandemic. In particular, Ms. Grimm stated that the OIG will be “looking at work examining the impact of expanded telehealth in Medicare.”

In addition to its Strategic Plan, earlier in May the OIG updated its Work Plan, which OIG uses to set forth its planned and ongoing agency inquiries, to reflect its planned audit of the $50 billion in general funds[1] that will be released to eligible providers. For that audit, OIG plans to obtain data and interview program officials to both review how those payments were calculated, and to review the payments for compliance with the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) requirements.

Thus, although it is not surprising that HHS OIG will mount a robust and coordinated oversight effort COVID-19 recovery funds, the Strategic Plan does serve as a reminder to providers that, especially during what may be a confusing and chaotic time for them, they must abide by the rules, regulations and contractual requirements placed upon relief funds, and that documentation around appropriate use of those funds and appropriate use of emergency flexibilities granted to them will be paramount in retaining those funds and withstanding future OIG scrutiny.

 

[1] As a reminder, eligible providers have until June 3, 2020 to submit their revenue information to support receiving additional payment from the $50 billion general fund. This is true both for providers who automatically received an additional General Distribution payment prior to 5:00 pm, Friday, April 24th, who must provide HHS with an accounting of their annual revenues by submitting tax forms or financial statements, and for those providers that have not already received an additional General Distribution payment, for which the submission of tax forms or financial statements to the portal will also serve as an application for additional funding. If these providers do not submit their revenue information by June 3, they will no longer be eligible to receive potential additional funding from the $50 billion General Distribution. Additional information is available at: 
https://www.hhs.gov/about/news/2020/05/20/providers-must-act-june-3-2020-receive-additional-relief-fund-general-distribution-payment.html.

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